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Fluconazole is an azole antifungal used for candidiasis and prophylaxis in immunocompromised children with excellent oral bioavailability.
Excellent CSF penetration makes it useful for cryptococcal meningitis maintenance and suppression after induction therapy (with specialist guidance).
Dose adjust in renal impairment because the drug is primarily renally cleared.
Monitor liver function tests for courses longer than 2 weeks or in hepatic disease—elevations are usually reversible.
Beware of QT prolongation when combined with other QT-prolonging medications (macrolides, methadone).
Extensive drug interactions via CYP2C9, CYP2C19, and CYP3A4 inhibition—review concomitant therapy carefully.
Fluconazole covers Candida species and some endemic fungi with excellent oral absorption.
Guideline use includes mucosal candidiasis, candidemia step-down, and prophylaxis in immunocompromised hosts.
| Condition | Age Range | First Line? | Notes |
|---|---|---|---|
| Oropharyngeal candidiasis | Infants, children, and adolescents | Yes | Use for moderate to severe disease or after topical azoles fail; treat for at least 7–14 days. |
| Esophageal candidiasis | Children and adolescents | Yes | Dose daily for at least 14–21 days and until symptom-free for 7 days. |
| Candidemia or invasive candidiasis (oral step-down) | Clinically stable children with susceptible isolates | Yes | Transition from IV therapy once blood cultures clear and gastrointestinal absorption is reliable. |
| Maintenance therapy for cryptococcal meningitis | Adolescents with HIV or immunocompromise | Yes | Use after amphotericin B plus flucytosine induction; continue for at least one year with immune reconstitution. |
| Antifungal prophylaxis in high-risk oncology or transplant patients | Children and adolescents | Yes | Use in hematopoietic stem cell transplant or intensive chemotherapy settings with prolonged neutropenia. |
| Refractory tinea capitis when first-line systemic agents are not tolerated | Children | No | Consider short courses under dermatology guidance when griseofulvin or terbinafine cannot be used. |
FDA-approved primary uses with Level A evidence
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Quick selection guides and diagnostic pearls
When to consider other medications
How to explain treatment to families
Fluconazole is generally well tolerated; liver enzyme elevations and GI symptoms occur most often.
Serious reactions include hepatotoxicity and QT prolongation with susceptible patients.
Nausea
Common • mild
Abdominal pain
Common • mild
Transaminase elevation
Uncommon • moderate
Hepatotoxicity
Rare • serious
Rash/Stevens-Johnson syndrome
Rare • serious
QT prolongation
Rare • serious
Organized by affected organ systems
How to discuss side effects with families
Management protocols and monitoring
Common concerns and practical guidance
Administration guidance for fluconazole in children.
Shake the suspension well. Give at the same time each day with or without food. For oral thrush, dose after meals and follow with good oral hygiene.
If using for oral thrush, avoid eating or drinking for 30 minutes after dosing. For IV-to-oral step-down, start oral dosing at the next scheduled dose.
Emergency contact: Seek urgent care for difficulty breathing, swelling, severe rash, or signs of liver injury such as yellowing eyes or dark urine.
Complete the prescribed course even if lesions clear early to prevent relapse.
Different formulations and concentrations
Safe preparation and measuring techniques
Tailored approaches for different ages
Solutions for common challenges
Storage guidelines and safety tips
Expert pearls and evidence-based tips
By inhibiting 14-alpha-demethylase, fluconazole depletes ergosterol and increases membrane permeability.
Fluconazole is a triazole antifungal that disrupts ergosterol synthesis.
Simple explanations and helpful analogies
Receptors, enzymes, and cellular targets
Absorption, metabolism, and elimination
Age-related differences and special populations
Fluconazole pearls for safe pediatric dosing.
Highlight renal adjustments, drug interactions, and monitoring.
Reduce maintenance dose by 50% when creatinine clearance <50 mL/min/1.73 m^2.
Check for warfarin, phenytoin, or QT-prolonging drugs before starting.
Obtain baseline and periodic liver enzymes for courses longer than 14 days.
Core insights every provider should know
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Organized by dosing, administration, and safety
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Understanding your child's medication is important. We've created comprehensive guides to help you safely administer Fluconazole and monitor your child's response to treatment.
Short courses for thrush usually do not. Longer treatment or higher doses may require periodic liver and kidney tests.
Yes. Unlike ketoconazole, fluconazole absorption is not affected by gastric pH.
Give it as soon as you remember. If it is close to the next dose, skip the missed one and return to the schedule.
Mouth symptoms often improve within 2 to 3 days, but continue therapy until the clinician stops it.